HomeMy WebLinkAboutCC 7 CLAIM #87-46 08-15-88h~BOI~0RABLE MAYOR AND CITY COUNCIL
FROH:
CITY ATTORNEY
CLAIMANT: MARTIN, DEBORAH; DJL: 11/9/87; DATE FILED
W/CITY': 12/18/87; CLAIM NO: 87-46; CARL WARREN FILE
NO: S52936NPH
SUBJECT:
After investigation and review it is recommended that the above-
referenced claim be rejected and the City Clerk directed to give
proper notice of the rejection to the claimant .and to the
claimant's attorney.
City Attorney
JGR (F4. se)
Enclosure:
Copy of Claim
CLAIM AGAINST THE' OF TUSTIN
('For Damages~Persons or Personal Prope R~~.i
U. S · Mail
Inter-office Mail -- 0~;c~-Ius~n
Over the Counter ~ ~ ~ ~
aim must
the City of Tustin within 100 days after which the incident or event occurre
Be sure your claim is against the City of Tustin, not another public entity.
Where space is. insufficient, please use additional paper and identify infor~
tion by paragraph number. Completed claims must be mailed or delivered to
Cit Clerk, The Cit of Tustin, 300 Centennial w~in, California 9268~
.
T~THE ~ONO~ LE
The undersigned respectfully submits the following claim and information re_
tire to damage to persons and/or personal property:
1. N~E OF CLAI~T: Debora Martin
a. ~DRESS OF CLAI~T:
b. PHONE NO: ( c. DATE OF BERTH:
SOCIAL DRIERS
d. SECURITY NO: e. LICENSE NO:
.
2. Name,. telephone and post office address to which claimant desires notic,
to be sent, if other than above:
STEPHEN C. HOSFORD, INC., 238 W. Main St., Suit~ 102, Tustin, CA 92680
714/730-8202
3. This claim is submitted against:
a. The City of Tustin only.
b. "' The following employee(s) of the City of Tustin only:
c. ~x
City of Tustin only:
not know the names of the employees .at this time.
4. Occu event from which the claim arises:
a. DATE: 11/9/87 b. ,TIME: 1200 c. PLACE (Exact
and specific location): intersection o~ Reahill Ave. & Warner, Cit
Tustin, CA
d. How and under what circumstances did damage or injury occur? Spec:
the particular occurrence, event, act or omission you claim caused
the injury or damage (use-additional paper if necessary).
· ' nal at the intersection was working improperly. See
The tr~l~.~n,a.l~a~nn~ ______ here ' ~nd
lC COLLI SION REPO--R-~a{%-ached
TRAFFIC COLbI:
~reference.
e. What particular action by the City, or its employees, caused the
le ed damage or injury? + .
a~l~ g~+,, ~ Tustin ~s re~le for mai~ t~h~e,traf,f_i_c_.._
· ~ further s_De----~ied in-x~~ "~" -- -'-------
'5. ~iVe a descriptioI the injury, property da ~ or loss so far as is
known at the time of this claim. If there wet= no injuries, state "no
injuries".
Flexion/extension injury to cervical re,ich, sprain - lumbar spine;
Property damage to vehicle" $3~000; Loss of earnings: Unknown
6- Give the name(s) of the City employee(s) causing the damage or injury:
Specifically unknQwn~ Generally the employees who are responsible
for maintaining.the signal.
7., Name and address of any other person injured: unknown
Name and address of the owner°of any damaged property: Allen C]inkscales
13882 Tustin East., #5, Tustin, CA 92680
Damages claimed:
·
a. Amount claimed as of this date: $3958.00
·
b. Estimated amount of future costs: $3000.00
c. Total amount claimed:
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.: See attachedr Exhibit "B"
Names and addresses of all witnesses, hospitals, doctors, etc. ~
a. Bernard E. Burton, D.C., 730 E1 Camino Real, Tustin, CA 92680
¢.
d.
Any additional information that ~ight be helpful in considering this claim:
I would like to separate this claim so that I would be paid for the.
property damages separately from the p~so~at ~njury.
~ING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM.. (Penal Code
Section 72; Insurance Code Section 556.0)
Z have read the matters and statements made in the above claim and I know the
sam~ to be true of my own knowledge, except as to those matters stated to be
u..l~on information or belief and as to such matters I believe the same to be true.
Z c~rtify under penalty of perjury that the foregoing is TRUE AND CORRE~.
:
~ted this ,/~" ~
day of December , 19 87 , at Tustin, California.
Off'ice of-the City Clerk,
T.ust'in, California
- -~ ~ - CIi~IMANT ' S SIGNATURE
Re.vised 8/05/81
JGR:se :R:8/5/81 (A)